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Arora S et al. Anterior open bite treatment with Mini-implants.
Case Report
Anterior open bite treatment with Mini-implants: A Case Report
Surbhi Arora, Roshni Shetty, Roopak D Naik
Department of Orthodontics and Dentofacial Orthopedics, S. D. M. College of Dental Sciences and
Hospital, Sattur, Dharwad – 580009 Karnataka.
Corresponding Author:
Dr. Surbhi Arora
H. No. Flat no- 404 B,
Anant Apartment,
Plot no- 25A, Sector 4, Dwarka,
New Delhi- 110078
E-mail id: [email protected]
Received: 20-07-2013
Revised: 18-08-2013
Accepted: 27-08-2013
Abstract:
Open bite malocclusion is considered to be one of the
most difficult problems to treat. The causes of the open
bite are multifactorial, which can develop form genetic
and or environmental factors. Reported here is a case
of 22 year old female anterior dental open bite with
crowding in the anterior segment. On clinical
examination and analysis, the case was diagnosed to be
Angle’s Class I molar relationship with Class I canine
relation, increased overjet of 4mm and negative
overbite for 3mm. The patient was successfully treated
using orthodontic mini-implants achieving a positive
overbite. Our results suggest that orthodontic implants
are useful for retraction of anteriors and maintenance
of anchorage in anterior open-bite cases.
Keywords: Anterior open bite, Mini-implants,
Hyperdivergent, Multifactorial
This article may be cited as: Arora S, Shetty R, Naik RD. Anterior open bite treatment with
Mini-implants: A Case Report. J Adv Med Dent Scie 2013;1(2):155-158.
Introduction
Open bite malocclusion in adults is
considered to be one of the most difficult
problems to treat because of its complicated
etiology1. The etiology of the open bite is
multifactorial: genetic and/or environmental
factors. The factors ranging from vertical
maxillary excess, abnormalities in dental
eruption, open bite skeletal pattern and
tongue posture problems2 contributes to this
condition making it a challenge for an
orthodontist. Open bite is generally
classified in two categories: skeletal and
dental. Further anterior open bite can range
from simple; limited to anteriors to complex
extending into the premolar and molar
region.
The diagnosis of open bite is the key to
success of the treatment with specific
criteria both in clinical and cephalometric
perspectives. The lack of further growth
potential restricts our ability to correct by
camouflage or orthognathic surgery, unlike
adolescents. Each case presents with variety
of treatment options, ranging from
observation or simple habit control to
complex surgical procedures. Therefore, the
success and stability of the treatment
depends on the presentation of each
individual after thorough assessment.
Orthodontic mini-implants have overcome
the limitations of camouflage orthodontic
treatment, especially in cases requiring
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Arora S et al. Anterior open bite treatment with Mini
Mini-implants.
surgery. They have been used to provide
anchorage for various types of tooth
movements, including intrusion, retraction,
protraction
raction of the posterior teeth and molar
uprighting. Cases with critical anchorage,
anchora as
in anterior open bite complicated with
tongue thrust implants can ease the
treatment. Here, we are presenting a case of
anterior open bite in an adult and its
management using mini-implants.
implants.
Case Report
A 22 year old female presented to us with
chief
ef complaint of space in front teeth and
difficulty in speaking. She had no relevant
medical history or previous orthodontic
treatment. On evaluation of the history and
clinical examination of the patient, a
diagnosis of anterior open bite was made.
The open bite was due to tongue thrusting
habit which leads to increased proclination
of the anteriors and localized open bite
(Figure 1). On extra-oral
extra
examination,
patient presented with increased lower
anterior facial height, hyperdivergent growth
pattern and incompetent lips (Figure 2).
Intraoral examination showed Class I molar
and canine relation, with localized anterior
open bite of 3mm and crowding in the upper
and lower anteriors. The panoramic
radiograph showed all erupted third molar
with no other abnormal finding (Figure
(Fig
3).
The cepahalometric analysis revealed
skeletal sagittal Class
II, vertical
hyperdivergent
growth
pattern
with
proclined upper and lower incisors. Lower
facial height and mandibular plane angle are
increased due to clockwise rotation
rota
of the
mandible.
Figure 1: Pretreatment intraoral photographs
Figure 2: Pretreatment Extra-oral
oral photograph
Treatment objectives were to achieve
positive overbite and ideal overjet with well
aligned upper
per and lower anteriors and a
pleasing profile. The etiology of the open
bite was simple tongue thrust habit,
Figure 3: Pretreatment panoramic radiograph
therefore skeletal rotation of jaw bases was
ruled out as the cause. The treatment
treatmen plan
involved an orthodontic camouflage line of
treatment, with need to extract all first
premolars to provide space for correction of
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Arora S et al. Anterior open bite treatment with Mini-implants.
crowding and the proclination of the
anteriors; achieving a positive overbite. The
clinical
examination
supported
by
cephalometric findings, suggested a critical
anchorage case, with the need to maintain
Class I molar relationship while retraction
and aligning the anteriors. To achieve ideal
results orthodontic mini-implants were
placed between the second premolar and
first molar (Figure 4). Considering patient’s
negative overbite, the implants were
anchored lower in the buccal cortical bone.
In treatment protocol 0.022 X 0.028” MBT
brackets were used for both the arches.
Following extraction of first premolars
(14,24,34 and 44), leveling and aligning was
done on 0.16” NiTi, 0.018” S.S and the
spaces were closed using implants on 0.019”
X 0.025” S.S with reverse curve of spee.
Keeping in mind the cause of open bite,
tongue exercises were taught to the patient.
For retention, upper and lower removable
wrap around retainer was advised, with a
hole made in the palatal aspect of upper
retainer to act as a reminder for the tongue
thrusting habit.
Figure 4: Intraoral photograph with mini-implants for retraction of anteriors.
Results: Angle’s Class I molar relation and canine relation was attained, with ideal an overjet and
positive overbite (Figure 5). The patients profile improved with notably better speaking abilities.
Figure 5: Post-treatment intraoral photograph
Discussion
Anterior open bite is one of the most
common
malocclusions
seen.
Its
multifactorial etiology and instability
highlights its importance for correct
diagnosis and treatment planning. The case
presented here with anterior open bite due to
tongue thrust, can be classified into dental
open bite. However, skeletal open bite
presents with open bite extending into the
molar region clinically and is due to the
downwards rotation of the mandible.2
Successful treatment of the adult patient
with dental or skeletal open bite pattern
often presents as a difficult challenge.
Dental compensation, such as uprighting the
posterior teeth, and uprighting and extruding
the anterior teeth, obtainable from multiloop
edgewise archwires3 can be optional for
borderline patients and those who are
reluctant to undergo surgery. However,
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Arora S et al. Anterior open bite treatment with Mini-implants.
intermaxillary elastics, used in conventional
and
multiloop
edgewise
archwire
mechanics, usually cause extrusion of the
posterior teeth4; this opens the mandibular
plane and has detrimental effects on the
facial profile. Therefore, vertical control of
the posterior teeth is crucial in the
orthodontic treatment of open bite.5 To
obtain an absolute anchorage, dental
implants7, screws8 and miniplates9 have
been used in orthodontics. Mini- implants
have been used to provide anchorage for
various types of tooth movements, including
intrusion of the anterior and posterior teeth,
retraction of the anterior teeth and the whole
dentition, protraction of the posterior teeth,
and molar uprighting. Their absolute
anchorage, small size, and simple and less
invasive surgical procedure could increase
their clinical use.10 Microscrew implants,
placed between the second premolars and
the first molars in the maxillary arch6, can
provide anchorage for anterior retraction and
posterior intrusion of the teeth. Kim3
stressed the importance of correcting the
cants of the occlusal planes and uprighitng
the posterior teeth against the occlusal plane
in managing open bite mesial tipping of the
posterior teeth can easily occur with
premolar extractions. Therefore, implants
should be used to control the posterior teeth
vertically and to retract the anterior teeth.
Conclusion
Negative overbite, either dental or skeletal
requires thorough diagnosis and treatment
planning. In adults the lack of growth limits
our treatment approach further. In
conclusion, for adults with dental open bite,
orthodontic camouflage assisted with miniimplants are successful for efficient
retraction of anteriors. Especially in critical
anchorage cases, with the habit of tongue
thrust further taxing the anchorage the miniimplants are efficient and successful.
References
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Tongue thrust therapy and anterior dental
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Source of support: Nil
Conflict of interest: None declared
Acknowledgement: Author would like to
thanks Dr. Anand K Patil, Dr. Sanjay V.
Ganeshkar and Dr. Sangamesh for their
guidance and support.
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